2025 CPT code 96522

Refilling and maintenance of an implantable pump or reservoir for systemic drug delivery.

Refer to the most current CPT coding guidelines and associated instructions for proper reporting of this procedure.

Modifiers 59 (distinct procedural service) may be applicable if additional procedures are performed on the same day. Other modifiers might apply depending on specific circumstances. Refer to the CPT manual for modifier usage guidelines.

Medical necessity is established based on the patient's ongoing need for systemic drug delivery via the implanted device.The procedure is medically necessary to maintain the therapeutic effect of the drug and avoid interruption of treatment.

The clinical responsibility includes assessing the functionality of the implanted pump or reservoir, refilling the reservoir with medication, and ensuring the device continues to deliver medication as prescribed. This requires expertise in implantable drug delivery systems and sterile injection techniques.

IMPORTANT For refilling and maintenance of an implantable infusion pump for spinal or brain drug infusion, use codes 95990-95991. For collection of blood specimen from a completely implantable venous access device, use 36591. For declotting a catheter or port, use 36593.

In simple words: The doctor refills and checks a device implanted in the body that delivers medicine over a long time. They make sure the device is working correctly and refills it as needed using a special needle.

This procedure involves refilling and maintaining an implantable drug pump or reservoir used for systemic drug administration (e.g., intravenous, intra-arterial).The provider assesses the functionality of the pump or reservoir, ensuring the medication is delivered as intended.Refilling is accomplished via an external needle injection through a self-septum in the pump.

Example 1: A patient with chronic pain has an implanted pain pump. The physician refills the pump with analgesic medication and checks its functionality., A patient with metastatic cancer receives chemotherapy through an implanted port. The oncologist refills the port with chemotherapy drugs and verifies its proper operation., A patient with diabetes requires continuous insulin delivery. The endocrinologist refills the insulin pump, checks for any malfunctions, and adjusts the dosage as needed.

** This code does not include the initial implantation of the drug delivery system.Separate codes are used for the placement of the device.This procedure requires adherence to strict aseptic techniques to prevent infection.

  • Revenue Code: P7B (ONCOLOGY - OTHER)
  • RVU: Information not available in provided source.Consult the most current CPT codebook or other relevant fee schedules for RVU data.
  • Global Days : Information not available in provided source.Global surgical days are not typically applicable to this type of procedure. Consult the most current CPT codebook for any applicable global period guidelines.
  • Payment Status: Active
  • Modifier TC rule: A Technical Component (TC) modifier is not typically applicable to this code as it represents a professional service.
  • Fee Schedule : Information not available in provided source. Consult historical fee schedules or databases for past reimbursement rates.
  • Specialties:Oncology, Pain Management, Endocrinology, Cardiology
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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